OBJECTIVE: This study sought to describe the characteristics and
consequences of untreated major depressive disorder. METHOD: As part of a
family study of probands with major affective disorders, raters assessed
3,119 first-degree relatives, spouses, and comparison subjects. When 2,237
(71.7%) of these individuals were reassessed 6 years later, 547 had
experienced episodes of major depressive disorder in the interval. Those
who had sought any form of treatment for any episode of major depressive
disorder in the interval were compared, by baseline demographic
characteristics and clinical features of their worst episodes of major
depressive disorder, to those who had not. Individuals who had had
untreated major depressive disorder were then compared, by changes in
socioeconomic status and by levels of psychosocial impairment at follow-up,
to a matched group with no major depressive disorder in the interval.
RESULTS: The worst episodes of 313 treated individuals, compared to those
of 234 untreated individuals, were characterized by older age, symptoms of
the endogenous subtype, longer durations, and the presence of disruption in
role function. Each of these factors contributed independently to the
distinction between treated and untreated episodes. Untreated individuals
experienced significant psychosocial impairment on follow-up but did not
show the economic disadvantages shown elsewhere for probands who began
follow-up as they sought treatment at tertiary medical centers.
CONCLUSIONS: These data suggest that illness characteristics and age
determine the decision to seek treatment for major depressive disorder.
Untreated depression is apparently associated with long-standing
psychosocial difficulties but not with serious economic consequences.